Dr. Morrison's interest in quality of life issues at the end-of-life has led him to focus on palliative care and geriatrics. Merging these two areas, his clinical and research work suggest that pain symptoms tend to be overlooked in patients presenting with dementia/delirium. Dr. Morrison's long-term objectives are to promote understanding of this issue and to enhance the quality of life of older patients through improved pain and symptom management. The overall objective of the research project is to examine the management of pain in hip fracture patients and the inter-related problem of delirium. The specific aims are to: determine the incidence and prevalence of pain and delirium in patients with hip fracture; describe the management of pain and delirium; identify risk factors for the development of delirium and for inadequate pain management; examine the relationship between delirium and pain on select patient outcome variables; and develop strategies and interventions to improve the management of delirium and pain. Patients entering the Mount Sinai Health System presenting with a hip fracture will be studied. All patients will be assessed daily through the fifth hospital or third full post-operative day and thereafter every other day through the ninth hospital day for the severity of their pain and for delirium. Information will be collected on specific processes of care that are used during the treatment course of these patients with particular attention to those processes that could lead to the development of pain or delirium and those directed at the management of these two conditions by concurrently following the course of the patients and by reviewing medical records. Patients will be followed longitudinally through their hospitalization and at 2 and 6 months with assessments of pain, functional status, morbidity, and mortality. In the final half of the five year project, the data collected from the initial phase of this proposal will be used to plan and test two interventions at the Mount Sinai Hospital. The first intervention will be directed at improving pain management. The second intervention will be randomized controlled trial evaluating the pharmacologic management of delirium. Dr. Morrison will engage in a number of educational activities in order to enhance his research and statistical analysis skills.